HEART FAILURE CLINICAL PATHWAY

Date
Day Admission Day 1 Day 2 Day 3 Day 4 and Discharge
Pt. starting to diurese Weight / edema down Weight / edema down Weight / edema down
Expected Improved lung sounds Labs within acceptable range Labs within acceptable range Labs within acceptable range
Outcomes O2 sat > 90% Diuresing continues Tolerating increased activity Tolerating increased activity
Resp.status improves Resp.status improves Resp.status improves

Nutrition ___Gm Na+ diet ___Gm Na+ diet ___Gm Na+ diet ___Gm Na+ diet
Previous home restrictions Previous home restrictions Previous home restrictions Previous home restrictions

Test / Treatments Foley needed? May d/c foley if present and

BMP diuresing decreased
BNP
CBC BMP BMP BMP
Dig level if on Dig
HgA1C if diabetes
Lipid Profile ECHO_____% If ECHO not documented this admission why not?
TSH
PT if on Coumadin
CXR
EKG Accurate I&O documented and Accurate I&O documented and Accurate I&O documented and weights recorded
ECHO_______% date________ weights recorded weights recorded
Accurate I&O documented

Medications Saline lock Reconcile discharge medications with physician

ACE Inhibitor / ARB (if not, why not?)
Aldactone Discharged on ACE / ARB? If not, why not?
Anticoagulant Heparin / Lovenox
Beta Blocker (if not, why not?) Discharged on Beta Blocker? Coreg / Toprol
Bowel protocol
Digoxin po / IV
Lasix IV
KCl
Reconcile home medications with
physician

Activity As per physician order: Progress activity as tolerated Patient tolerating increased activity?
Bedrest Order PT/OT if needed.
Up with assistance
BRP
Up ad lib
Physicial Wt__________ Ht_________ Wt__________ Wt__________ Wt__________
Assessment Nursing assessments Nursing assessments Nursing assessments Nursing assessments
Dig level (if drawn) ____________ K+_____________ K+_____________ K+_____________
K+_____________ BUN/CR_______________ BUN/CR_______________ BUN/CR_______________
BUN/CR_______________ Hgb__________________ Hgb__________________ Hgb__________________
Hgb__________________ BMP_________________ Pulse ox______________ Pulse ox______________arrange home O2 if needed
BNP_________________ Pulse ox______________ Telemetry Telemetry
Pulse ox______________ Telemetry
Telemetry
Date:
 Admission Day 1 Day 2 Day 3 Day 4 and Discharge

Patient Orient to patient pathway, unit and routines Confirm consults have seen patient Continue to reinforce information: Patient able to verbalize understanding of the need
Education Assess readiness to learn Begin reviewing discharge Need to weigh daily at the same for:
Begin education if appropriate instructions with patient: time wearing the same amount of Weighing daily at the same time wearing the
Initiate other consults if needed: Need to weigh daily at the clothing same amount of clothing
Skin Care same time wearing the same Low sodium diet Low sodium diet
Nutrition Services amount of clothing Medications Medications
Social Work (assistance with Low sodium diet Signs / symptoms when to notify Signs / symptoms when to notify physician
meds, no insurance) Medications physician Need to keep follow-up appointments
PT/OT if needed Signs / symptoms when to Need to keep follow-up Activity restrictions
notify physician appointments
CHF discharge orders and instructions Need to keep follow-up Activity restrictions
are appropriately placed in patients appointments Patient has viewed CHF education and questions
chart Activity restrictions Patient to view CHF video or watch the have been answered.
CHF education of the Patient Channel
Smoking Cessation documented (if CHF discharge orders and Smoking Cessation documented (if applicable)
applicable) instructions are appropriately Smoking Cessation documented (if
placed in patients chart applicable) CHF discharge orders and instructions are
appropriately placed in patients chart
CHF discharge orders and
instructions are appropriately placed
in patients chart

Discharge Patients living situation: Care manager to address Discharge needs addressed / finalized Needs addressed / finalized.
Planning Alone discharge needs.
Family Home care___________ Home care / rehab arranged if needed
Current with home care?
SNF / ALF Rehab__________ Transportation arranged

Plan for transportation home? SNF___________ Home O2 set up and patient has tank
_______________

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